Diagnostic Procedures
Obtain a biopsy specimen of the lesion to establish the diagnosis. Numerous sebaceous elements with mitotic figures are observed; the cells may stain positively for fat with oil red O stain. The tumor can be multicentric, and it may grow into nests with central necrosis mimicking comedocarcinoma of the breast. Individual tumor cells may be present in the epithelium in a pattern of intraepithelial spread reminiscent of Paget disease. Therefore, it is recommended to perform multiple conjunctival map biopsies at the time of the initial lesion biopsy to stage the local disease.
It is good clinical practice to obtain a biopsy specimen of any recurrent chalazion or unilateral blepharitis that is resistant to usual treatment. It is also advisable to alert the pathologist to the possible diagnosis and ask for the preferred method of tissue handling. Formalin fixation is fine if the laboratory staff know to avoid alcohol and xylene histoprocessing methods.
Evaluate lymph nodes to rule out distant spread.
Histologic Findings
The histopathology of sebaceous gland cell carcinoma is dominated by large anaplastic cells with open vesicular nuclei and prominent nuclei set in foamy or frothy cytoplasm. The appearance of the cytoplasm is a result of the presence of lipid vacuoles. A useful histopathologic feature is large nuclear forms, including multinucleated tumor cells and bizarre monstrous cell forms. The spread of the tumor in the form of infiltrating lobules, nests, and cords, as well as superficially within the epithelium, is highly characteristic.
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A 63-year-old white man with lower eyelid sebaceous cell carcinoma and lash loss is shown.
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Gross pathology slide of sebaceous cell carcinoma, from same man as seen in image above.
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Microscopic pathology slide of sebaceous cell carcinoma, from same man as seen in images above.
